Acute Coronary Syndrome (ACS) Flashcards
Whats is ACS?
ACS is:
Blood flow through coronary artery either stopped, causing infarction, or severely reduced, causing ischaemia.
Clot from a plaque rupture leading to thrombosis and inflammation
Can also be caused by emboli (eg: fat or air)or coronary artery spasm (eg: from cocaine)
What are the risk factors of developing an ACS?
The risk factors for developing and ACS include:
- Age men >45 - women >55
- Sex M:F ratio 4:1
- PMSH HTN DM Hyperlipidaemia Resent surgery <3/7 Pregnancy
- FH IHD, CVA
- SH Smoking, Obesity
What are the potential symptoms of an ACS?
Symptoms of an ACS include:
- Site - Central chest pain
- Onset - Sudden
- Character - Crushing
- Radiation - Jaw and arms
- Associated symptoms - Nausea, sweating, SoB
- Timing - >20min
- Elevating/exacerbating - NOT relieved by rest
- Severity - MI maybe silent (no chest pain) in DM or in elderly
What are the potential signs of an ACS?
The signs of an ACS include:
- Anxiety/distress
- Pallor
- Pulse or BP changes
- Signs of acute heart failure
- Raised JVP
- 3rd HS
- Basal creps
- Pan-systolic murmur
- +/- ECG changes
What investigations should be done in to ACS?
Investigation in to ACS should include:
- ECG
- CXR
- Bloods
- NB: DON’T DELAY PCI for INVESTIGATIONS IN STEMI
- Look for non-cardiac causes of the pain
What are the treatment options for ACS?
Treatment for ACS includes:
Life style
- Smoking cessation Diet & exercise
Medical
- Aspirin
- GTN
- Oxygen (if hypoxic)
- Morphine
- Clopidogrel/Ticagrelor
- Beta blockers
- NSTEMI (where there is no PCI) Fondaparinux and/or LMWH
On discharge
- Aspirin
- ACEI
- Beta blocker
- Statin
Surgical
- PCI - STEMI & some NSTEMI
- CABG
What are the complications of an ACS?
Complications of ACS include:
- Cariogenic shock
- Arrhythmia
- Pericarditis
- Embolism
- Aneurysm Rupture (ventricle, free wall, papillary muscle)
- Dresslers syndrome
- fever
- pleuritic pain
- pericardial effusion
- 2-10 weeks post MI
What is the pathophysiology of ACS
The pathophysiology of ACS:
- Fatty streak formation
* lipids + vascular injury + white cells = foam cells - Fibrolipid plaque formation
* thinning of muscular media - Complicated atheroma
- If plaque ruptures and occludes = infarction (MI)
- If plaque ruptures and partially occludes = ischaemia (angina)
What are the types of ACS?
There are 3 types of ACS
- STEMI - ST Elevation MI
- NSTEMI - Non-ST Elevation MI
- Unstable Angina - ACS typr pain not releaved by rest or GTN
What might be signs of ACS on a 12 lead ECG?
Signs of ACS on an ECG include:
- ST elevation (2 or more consecutive leads)
- New LBBB
- ST depression
- Q waves Hyperacute T waves
- Inverted T waves
- Arrhythmias
What blood should be done is ACS is suspected?
Bloods for ACS should include:
- FBC
- U&Es
- lipids
- Trop I & T
What would you look for on a CXR if you suspected ACS
If you suspect ACS look for signs of:
- Acute heart failure
- Cardiomegaly
- Pulmonary oedema
- Widened mediastinum
- Another cause of the chest pain
What are the causes of ACS
The causes of ACS include:
- Atherosclerosis plaque rupture
- Emboli (?fat)
- Coronary artery spasm
